1124: IMPLEMENTATION OF A PEDIATRIC NEUROCRITICAL CARE PROGRAM AT A LARGE CHILDREN’S MEDICAL CENTER

Background Unsuccessful extubation is associated with increased intensive care unit and hospital length of stays, hospital costs, morbidity, and mortality. The most common cause of reintubation is laryngeal edema, often evidenced by postextubation stridor. Objective To reduce the rates of postextubation stridor and reintubation in the neurocritical care unit at a large urban academic medical center. Methods A clinical pathway was created to aid in detecting patients expected to experience postextubation stridor and to guide prophylactic treatment. During the 12-week implementation phase, the pathway was completed on all intubated patients daily. Results The 12-week trial included a total of 606 days of mechanical ventilation. Checklists were completed for 531 days, a compliance rate of 88% for use of the clinical pathway. Of the 56 patients who were extubated during the trial, 54 had a checklist completed, for 96% compliance on the day of extubation. Outcomes after all nonpalliative extubations (n = 43) during the 12 weeks before and after implementation of the pathway (n = 56 periods) were evaluated by using χ2 tests. Implementation of the pathway was associated with a significant reduction in rates of postextubation stridor (χ2 = 6.2; P = .01), reintubation (χ2 = 5.5; P = .02), and reintubation due to postextubation stridor (χ2 = 8.3; P = .004). Conclusion The clinical pathway implemented in the neurocritical care unit was safe and effective in reducing rates of reintubation and reintubation due to postextubation stridor.

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Pediatric Neurocritical Care: Special Considerations

Brain Injury Medicine ◽

10.1891/9781617050572.0035 ◽

2012 ◽

Author(s):

Kristin Guilliams ◽

Andranik Madikians ◽

Jose Pineda ◽

Christopher C. Giza

Keyword(s):

Neurocritical Care ◽

Pediatric Neurocritical Care

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The Effect of a Methadone Treatment Program Upon Pregnant Heroin Addicts and Their Newborn Infants

PEDIATRICS ◽

10.1542/peds.54.3.300 ◽

1974 ◽

Vol 54 (3) ◽

pp. 300-305

Author(s):

Rita G. Harper ◽

George I. Solish ◽

Henry M. Purow ◽

Edward Sang ◽

William C. Panepinto

Keyword(s):

New York ◽

Psychosocial Support ◽

Past History ◽

Medical Center ◽

Methadone Treatment ◽

Newborn Infants ◽

Care Program ◽

State University ◽

Downstate Medical ◽

History Of

A Family and Maternity Care Program (FMCP) for pregnant addicts, their spouses and the newborn infants was organized at the State University of New York Downstate Medical Center. Twenty-five percent of the women were treated for syphilis; 18% had a recurrent or recent past history of hepatitis. Obstetrical complications were reduced or eliminated by careful obstetrical surveillance. None of the mothers signed out against medical advice postpartum. Of the 51 living infants delivered within the study period, there were 17 infants weighing less than 2,500 gm. The Apgar score at one minute was 7 or higher in 84% of the infants. An excessive incidence of congenital malformation was not seen. Ninety-four percent of the infants developed withdrawal symptoms, 6% of whom convulsed repetitively. Infant withdrawal, however, was unassociated with an increase in mortality or known prolonged morbidity. This low-dose methadone program coupled with intense psychosocial support appeared to alleviate many of the common problems associated with addiction in pregnancy, but failed to prevent withdrawal in the newborn.

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